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Health & Welfare Plans Newsletter

July 18, 2024

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[Official Guidance]

CMS Notice of Enforcement Safe Harbor for Individual Market Product Discontinuation Notices (PDF)

"Consistent with previous guidance, in connection with the open enrollment period for coverage in the 2025 benefit year, CMS will not take enforcement action against an issuer for failing to provide a product discontinuation notice with respect to individual market coverage at least 90 days prior to the discontinuation, as long as the issuer provides such notice consistent with the timeframes applicable to renewal notices."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself' Software Instructions for the 2024 Benefit Year (PDF)

28 pages; Jul. 17, 2024. "(CMS) has created two versions of software and software instructions for issuers to use with their enrollment data to simulate their enrollee populations' 2024 benefit year risk scores within the HHS-HCC risk adjustment models. This software is being issued only as a supplemental tool for issuers of risk adjustment covered plans to better understand and simulate the calculation of plan liability risk scores for their enrollees" [Also available: Technical Details (XLSX) and 2024 Benefit Year Risk Adjustment SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

Sixth Circuit: Jury Must Make Factual Determinations in FMLA Lawsuit

"the Sixth Circuit determined that a jury must decide whether an employee's failure to follow her employer's leave procedures was due to 'unusual circumstances,' thereby permitting her to sue the employer for a violation of the [FMLA]." [Crispell v. FCA US, LLC, No. 23-1114 (6th Cir. Jun. 18, 2024)]  MORE >>

The Wagner Law Group

Eleventh Circuit: No Pre-Birth FMLA Leave Entitlement for Unmarried Expectant Father

"[T]he court explained that while the FMLA provides bonding time to both parents beginning with the child's birth, pre-birth FMLA leave is generally available only to an expectant mother who is incapacitated due to pregnancy or to a spouse who is caring for an incapacitated pregnant spouse." [Tanner v. Stryker Corp. of Michigan, No. 22-14188 (11th Cir. Jun. 20, 2024)]  MORE >>

Thomson Reuters / EBIA

District Court Rules That Guardian Did Not Waive Its Right to Cancel Group Life Insurance Plan Due to Low Participation

"Guardian cancelled the group plan effective January 15, 2022, due to low group participation. After the plan had been cancelled, Guardian did not receive any additional premiums ... Decedent passed away on May 27, 2022.... The agent claims it is customary in the business that the agent is provided with notice of any cancellation and that no such notice was sent to the agent.... The Court held that upon cancellation, the group life plan no longer existed, and Plaintiff had no claim for benefits under the plan. " [Edwards v. Guardian Life Ins. of Am., No. 22-0145 (N.D. Miss. Jul. 12, 2024)]  MORE >>

Roberts Disability Law

Projected 2025 Transportation and Health FSA Limits

"Limits for qualified transportation fringe benefits and health FSAs are expected to rise moderately in 2025, due to the anticipated increase in average C-CPI-U for the year (estimated to be 2.7% to 3.1%)."  MORE >>

Mercer

Medical Stop-Loss Premiums Increase by More Than 9%

"The average stop-loss coverage premium increase is 9.4 percent for the nearly 240 health plans in Segal's 2024 national medical stop-loss dataset. The average includes groups that increased specific stop-loss deductible levels and/or aggregating specific stop-loss deductibles resulting in an overall reduced rate action. The average premium increase for groups that maintained similar specific stop-loss benefit levels as the prior year is 11.5 percent."  MORE >>

Segal

Ideas for Promoting Benefits This Open Enrollment Season

"[1] Employee ambassador programs ... [2] Storytelling and testimonials ... [3] Interactive webinars and Q&A sessions ... [4] Personalized benefit statements or customized infographics ... [5] Pop-up booths and events ... [6] Creative communication channels ... [7] Microlearning modules ... [8] Gamification ... [9] Pop-ins by leadership ... [10] Interactive benefit decision tools.'

   MORE >>

Benefitfocus

CMS Releases Report on No Surprises Act Audit

"The report lists three violations uncovered in the audit, and the corrective action taken to resolve them: ... [1] Failing to properly calculate the QPA by using claim paid amounts instead of contracted rates and counting each claim as its own contracted rate, even when the claims were for the same amounts for the same item or service and to the same provider of air ambulance services.... [2] Failing to provide a statement that provider may initiate the independent dispute resolution (IDR) process within four days after the end of the open negotiation period.... [3] Failing to provide the QPA with an initial payment or notice of denial of payment."  MORE >>

Miller & Chevalier

Benefits in General

Service Agreements Can Create Headaches for EBP Audit Firms

"EBP sponsors often use third-party service organizations to perform administrative functions. Terms that auditors may be required to agree to before gaining access to materials needed for the audit may be included in NDAs, confidentiality agreements, business associate agreements, and data protection agreements. The EBPAQC letter details nine examples of potentially troublesome provisions that auditors may be asked to accept in the process of accessing a service organization's portal in order to obtain data needed to perform an ERISA audit."  MORE >>

Journal of Accountancy

IRS Form 5500 Reconciliation

"[I]nconsistencies are most often classification or timing differences resulting from inconsistent use of the cash and the accrual methods of accounting. When inconsistencies indicate that there is an error, then the misstatements should be corrected if they are material. One would expect the application of the accrual basis to be defined consistently by the Generally Accepted Accounting Principles (GAAP) and the Form 5500 instructions, but there are many differences worth noting"  MORE >>

Belfint Lyons Shuman

Employee Benefits Jobs

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Selected New Discussions

Use of FSA Rollover If Not Contributing in Subsequent Year?

"Client has FSA that allows rollover of unused FSA balance up to IRS maximum. Plan year is 7/1-6/30. For 2023 PY, employee had unused funds that rolled over 7/1/24; however, employee did not elect to make contributions for 2024 PY (and there are no employer contributions to the FSA). Can the employee use the rollover from 2023 PY for expenses incurred in 2024 PY? My initial reaction is the employee is not a participant in the FSA for the 2024 PY so they cannot submit for reimbursement of expenses in 2024 PY. Do we treat the employee similar to a terminated employee and allow a run-out period to spend down their rollover balance?"

BenefitsLink Message Boards

Press Releases

MMM’s Employee Benefits & Executive Compensation Practice Ranked By Chambers USA 2024, Legal 500

Morris, Manning & Martin, LLP

Webcasts and Conferences
(Health & Welfare Plans)

Agency Regulations in the Cross-Hairs: Supreme Court Tosses Out Chevron Deference

RECORDED

Groom Law Group

Pregnancy and Parental Leave: Legal Framework and Recent Developments for Employers to Consider

September 18, 2024 WEBINAR

Dentons

Last Issue's Most Popular Items

Must a Self-Funded Group Health Plan Cover Gender-Affirming Care?

Bricker Graydon

IRS Issues FAQs on Educational Assistance Programs

Groom Law Group

Eighth Circuit Greenlights Cross-Plan Offsets

Kantor & Kantor

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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